下肢小型无绿藻感染1例

摘要/Abstract

摘要： 患者,男,39岁,8年前体检时发现全血细胞减少,行骨髓、流氏细胞术等检查确诊阵发性夜间血红蛋白尿(paroxysmal nocturnal hemoglobinuria,PNH)后,长期服用"环孢素、泼尼松"治疗,2个月余前左下肢部位皮肤划破后出现破溃伴红肿热痛,取创面组织及分泌物行病理检查与病原学检测,选用哌拉西林/他唑巴坦经验性抗感染治疗。在确诊为小型无绿藻所致左下肢软组织感染,药敏试验提示其对两性霉素B敏感后,更改抗菌药物为两性霉素B静滴:首日1 mg试针,第2~4日10 mg,第5~10日剂量增加至25 mg,每日一次。10天后因肌酐升高,将用量减至15 mg,隔日一次,同时进行创口护理,经对症治疗1个月后复查,患者左下肢皮肤破溃无明显炎性分泌物,创面已基本愈合。

关键词: 阵发性夜间血红蛋白尿, 小型无绿藻, 软组织感染, 两性霉素B

Abstract: A 39-year-old man was found to have reduced blood cells during physical examination 8 years ago. Cyclosporine and prednisone were taken for a long time, after undergoing bone marrow, flow cytometry and other examinations to diagnose paroxysmal nocturnal hemoglobinuria (PNH). More than 2 months ago,his left lower extremity was scratched, accompanied by ulceration, redness, swelling and pain. Recently he had been admitted to the hospital and immune indicators were reduced, accompanying by secondary hyperglycemia. Wound tissues and secretions were taken for pathological examination and pathogenic testing. Piperacillin/tazobactam was used for empirical anti-infective therapy. After being diagnosed with Prototheca wickerhamii infection, the antibiotic was replaced by amphotericin B according to antimicrobial susceptibility testing. The dosage of the 1st day was 1 mg, the 2nd to 4th days were 10mg and 5th-10th days were 25 mg once a day. Due to elevated creatinine,the dosage was reduced to 15 mg every other day and wound care was performed at the same time. At last, there was no obvious inflammatory secretion and the wound had healed, when re-examining one month later.

Key words: paroxysmal nocturnal hemoglobinuria(PNH), Prototheca wickerhamii, soft tissue infections, amphotericin B

中图分类号:

R 519.5

赵越, 凌勇, 欧阳峰, 阙熳芳. 下肢小型无绿藻感染1例[J]. 中国真菌学杂志, 2023, 18(3): 254-256,260.

ZHAO Yue, LING Yong, OUYANG Feng, QUE Manfang. A case of Prototheca wickerhamii infection in lower limbs[J]. Chinese Journal of Mycology, 2023, 18(3): 254-256,260.

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